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Tuesday, March 27, 2007

Coming to terms with size and self

For more than six decades, Michael Berman has lived as a fat person. At 5 feet 9 inches, he has weighed as much as 207.5kg. He has been known to eat three racks of ribs at one sitting, or a 40-ounce steak, or a whole box of saltines. In 1986, after dropping a few pounds, he spent US$2,100(RM7,770) on three custom-made, pinstripe suits. By the time the suits were ready, 10 weeks later, they no longer fit. Eleven years after that he gave them away, having never worn them.

A highly successful political campaigner and Washington lobbyist, Berman, 66, doesn't deny the dangers of fatness or the urgency of encouraging people to exercise and eat healthier. He acknowledges that with 60% of the US population overweight or obese, being fat has serious consequences for the health of individuals and the economy. He'd like to see resources used for a public education campaign similar to that for smoking and seatbelt use.

But forget the notion that fat people can become slim, he says in a new book that is part memoir, part self-help book. They can and should, manage their weight. They can, and should, find an exercise programme they can stick with. But fat adults will always be fat. They are in the grips of a disease over which, in the end, they do not have complete control.

“The idea that you can slim doen by willpower is a bunch of horse manure,” he says. If “nonfat” people could be convinced of this, perhaps they'd start relating better to fat people.”

He is comfortable with being different, now. But he has suffered through countless weight swings, 20 diet programmes, a kidney infection and knee surgery. It has taken eight years of counselling, the careful attention of a personal trainer/nutritionist, and his wife's sustained support to get to that place.

Berman first realised he was not just husky but really fat when, at 13 about 170 pounds, he was in the shower of the boy's locker room after gym. A boy grabbed his chest, saying he wanted to know what it felt like to touch a girl's breast, Berman recalls in Living Large:A Big Man's ideas on Weight, Success and Acceptance, written with Laurence Shams. That was just one of thousands of indignities he would encounter or bring upon himself.

One afternoon in law school, reading in a wooden armchair, he started to get up only to realise he was stuck. “My hips were captured; my bottom stayed glued to the chair and the whole thing lifted up with me as i tried to stand,” he writes. “ I felt all eyes on me,” and decided to play the clown. “Still crouched over, taking small, constricted steps, I carried (the chair) across the room, somewhat like a turtle with its shell, and sat down once again.

Today he winces at all the times he played the jolly fat man: leading college cheerleaders onto the football field by pedalling a miniature girl's bike, playing Santa Claus at White House Christmas parties. Perhaps such experiences were why he could ignore the advice of a friend who tried to steer him away from writing a book about his fatness, saying it would be “undignified”.

As a teen, Berman realised that to be taken seriously and make something of his life, he would have to develop talents. His parents taught him ballroom dancing-the first thing, he writes, that his rotund body was good at. He managed his first political campaign in junior high for a girl running for student council president. She lost, but he learned he could succeed in politics behind the scenes. He didn't need to be cute, just hardworking, shrewd and resourceful.

Life together with his wife Carol has been good, although Carol had to make a couple of what she Calls”accommodations”. The hardest for her was being unable to have children. A fertility specialist told the couple that his sperm count might be a factor; fat men tend to haver a lower number.

In 1998, he started jotting down thoughts and memories about being fat with the idea of writing a book someday. The exercise became an obsession. He read scientific reports and researched cultures of the past in which fatness was considered a symbol of wisdom, serenity and wealth.He read that for some people, fatness is genetic. But that wasn't true for him, so he began to develop his own theory.

The easy answer, of course, is that fat people take in more calories than they burn. Then it gets more complicated, he writes. Each person's metabolism is different. He , his sister and his parents all ate a lot of his mother's delicious cooking and none exercised much. But he was the only one who got fat.

Emotions play a role, too. From age four, he sneaked food into his bedroom. “Something was driving me,” he writes, “something that was beyond the reach of willpower, outside the realm of reason.”

he and his psychologist came to believe his compulsion started partly as a reaction to his mother. She showed her affection by cooking rich meals and he showed his affection by eating lots of it. As he got heftier in early adolescence, she started withholding food and he ate as a way of asserting his emerging will.

Eventually he had to admit that he was an addict. But unlike alcoholics or drug users, he couldn't go cold turkey: “The most difficult thing about a food addiction is that you can't give up food.”

he pulls out a tiny notebook in which he records his daily food intake and exercise. On one day, suddenly: 4,465 calories.

What happened that day? He couldn't resist the chocolate cake at a dinner party. “I ate probably eight ounces of chocolate,” he admitted. “But i don't beat myself up anymore. I knew I'd be heavier the next morning so the next couple of days I'd be careful.”

a couple of years ago, he wouldn't have been so sanguine. But if there was one thing he had learned in writing his book, it was this : “Managing fatness means accepting ourselves as who we are....in short, learning to live a full and satisfying life at whatever weight and size we happen to be.”

Saturday, March 17, 2007

Treat depression

ANYONE can develop depression. But the good news is that treatment is successful in about 80% of identified cases. Psychotherapy and medication are the two primary treatment approaches. Antidepressant medications can make psychotherapy more effective for some people. Someone who is too depressed to talk, for instance, may not get much benefit from psychotherapy or counselling; but often, the right medication will improve symptoms so that the person can respond better.

“Regarding depression as 'just' a chemical imbalance wildly misconstrues the disorder. It is not possible to explain either the disease or its treatment based solely on levels of neurotransmitters,” says Yale University neurobiologist Ronald Duman, Ph.D.

It is important for you to be well informed about medications for depression if you are taking any of these medications, but this is not a “do-it-yourself” column. Self-medication can be dangerous. Interpretation of both the signs and symptoms of depression, and identification of possible side effects, are jobs for the professional.

The prescription and management of medications, in all cases, muct be done by a physician working closely with the patient, his/her psychologist, and sometimes the patient's family.

Medication-not a cure allJust as paracetamol can bring down a fever with-out clearing up the infection that causes it, psychotherapeutic medications act by controlling symptoms. Like most drugs used in medicine, they correct or compensate for some malfunction in the body.

Psychotherapeutic medications do not cure depression. In many cases, these medications can help a person get on with life despite some continuing mental pain and difficulty coping with problems.

For example, antidepressants can lift the dark, heavy moods of depression. The degree of response ranging from little relief of symptoms to complete remission depends on a variety of factors related to the individual and the particular disorder being treated.

As to how long a person must take a psychotherapeutic medication depends on the disorder. Many depressed and anxious people may need medication for a single period, perhaps for several months, and then never have to take it again. For some cases of depression, medication may have to be taken indefinitely or, perhaps, from time to time.

Like any medication, psychotherapeutic medications do not generate the same effect in everyone. Some people may respond better to one medication than another. Some may need larger dosages than other. Some experience annoying side-effects, while other do not. Age, sex, body size, body chemistry, physical illnesses and their treatments, diet, and habits such as smoking, are some of the factors that can influence a medication's effect.

Types of depression medicationAntidepressant drugs are effective in the treatment of major depression of moderate and severe degree including major depression associated with physical illness and that following childbirth; they are also effective for dysthymia (lower grade chronic depression). Antidepressants were first used in the late 1950s. Now they are divided into three main classes:

Tricyclic drugs (TCAs)TCAs and related antidepressants can be roughly divided into those with additional sedative properties and those that are less so. Agitated and anxious patients tend to respond best to the sedative compounds whereas withdrawn and apathetic patients will often obtain most benefit from the less sedating ones.Those with sedative properties include amitriptyline, clomipramine, dosulepin (dothiepin), doxepin, maprotiline, mianserin, trazodone, and trimipramine.Those with less sedative properties include amoxapine, imipramine, lofepramine, and nortriptyline.

Monoamine oxidase inhibitors (MAOIs)MAOIs are used for all types of depression. They have also been used when “atypical” features are present with the depression such as excessive sleeping, overeating and anxiety. Some examples are phenelzine, isocarboxazid and tranylcypromine. Phobic patients and depressed patients with atypical, hypochon-driacal, or hysterical features are said to respond best to MAOIs.

Selective serotoninreuptake inhibitors (SSRIs)These were developed in the 1980s and are the most commonly prescribed today. Citalopram, escitalopram, fluoxetine, fluvoxamine, paroxetine, and sertraline selectively inhibit the re-uptake of serotonin (5-hydrox-ytryptamine, 5-HT); they are termed selective serotonin re-uptake inhibitors (SSRIs). Serotonin and Norepinephrine Reuptake

Inhibitors (SNRIs) are newer “reuptake inhibitors” that work on blocking the reuptake of different neurotransmitters (brain chemicals). An example would be Venlafaxine. In general SNRIs cause fewer side-effects than TCAs and MAOIs.

Another type is bupropion, which is a dopamine reuptake blocking compound. It acts on the neurotransmitters dopamine and norepinephrine.

How effective is depression medication?Many people find great relief by using antidepressants. They can be effective in giving a quick response, to relieve suffering in severe cases of depression. But the long-term use of antidepressants is far from the being the answer to depression. Also, as we have seen, if you are depressed, you need to learn the skills necessary to avoid depression in the future, not just treat the symptoms with drugs.

Does osteoporosis occur in men?

OSTEOPOROSIS is a disease of women, right? Wrong-osteoporosis can be just as common in men if they live long enough. Men start off with a greater bone mass so osteoporosis occurs at a later age, roughly 5-10 years later than women. In the past many men died before osteoporosis had a chance to develop, but now that many men are living into the 70s, we are discovering that male osteoporosis is becoming a major problem.

What can men do about it? Is it any different from osteoporosis in women? Is there an equivalent HRT for men?

Enter the vitalsexual man

FORGETthe metrosexual, here comes the vitalsexual man! He is at least 40, consideers spontaneity in sex and parthner satis-faction to be very important and is willing to seek medical help if he has sexual problems.

Results form a recent Malaysian study of 1,000 men have revealed the emergence of a new socio-sexual type-the vitalsexual. He is a man who wishes to have an active and satisfying love life for both his partner and himself.

Announcing the findings of the study, consultant urologist Dr Zulkifli Md. Zainuddin said: “The man the Vitalsexual study has highlighted is one whom we are beginning to see more of in our practice. He is more aware of his sexual problems and is more willing to discuss and use medication to maintain the spontaneity of his relationship and to satisfy his partner.”The study, commissioned by Bayer HealthCare and conducted by independent research agency Taylor Nelson Sofres (TNS), is believed to be the first local study of this scale to specifically examine sexual opinions, concerns and attitudes of men in Malaysia.

The key local study findings indicating the emergence of the new “Vitalsexual” group are:

39% of men over 40 are vitalsexuals

More vitalsexuals view sex as important compared with all Malaysian men (56% vs 41%)

More vitalsexuals would like to improve their sex life by giving more pleasure to their partners compared with other men aged 40++(60% vs 53%)

Vitalsexuals would like more frequent sexual relations compared with other men aged 40++(27% vs 16%)

Vitalsexuals would like to inject more spontaneity into their sexual relations compared with other men aged 40++ (31% vs 26%)

Vitalsexuals are typified by their generous attitude towards their parther's satisfaction and the need for spontaneity. Vitalsexuals say it is important or essential to give satisfaction to their partner when they have sex. They also expressed that it was important or essential to have spontaneous love relationships.

“The common assumption is that Asian men are self-centered and don't care about partner satisfaction. But the study debunks the myths. This is good news for women!” said chartered psychologist Prof Dr Low Wah Yun.

“Many Malaysian men still think of erection difficulties as a taboo topic. This is a paradox as they also desire for greater partner satisfaction. They can have that if they are more open and proactive in seeking solutions. Women too can play an important role in improving sexual relations by encouraging their men to talk about their erection difficalties with their doctors,” added Prof Dr Low.

Summing up the Vitalsexual man, Lin Siew Kheng, general manager Bayer Healthcare Pharmaceuticals (Singapore, Brunei, Malaysia, Vietnam), Bayer (South East Asia) Pte Ltd, said: “Results of this study point to a need for more vitalsexuals-men who are more concerned about the cople he is part of rather than just himself-in our society. When society has more vitalsexuals, it will have happier couples and marriages.”

The Vitalsexual Malaysia Study is part of an extensive global research programme supported by Bayer Healthcare to bring attention to the fact that there are an estimated 152 million men worldwide who experience erection difficulties. Despite its prevalence, only around 15-20% of men with the condition are being treated.

Friday, March 16, 2007

Nurturing the thinking child

Brain-Based learning is the informed process of using a group of practical strategies based on sound principles derived from brain research. It aims to help children learn according to how the brain learns best-naturally. It is a borderless approach to learning, crossing and drawing upon multiple disciplines such as chemistry, neurology, psychology, sociology, genetics, physiology and nutrition. This holistic and multidisciplinary approach increases the learning potential of every child.

Brain based learning theorists believe that optimal learnin occurs in five stages.

Pre-exposure

Acquisition

Elaboration

Memory formation

Functional integration Here are information about these five stages and how parents can help strengthen learning at each stage.

Pre-exposureAlso known as preparation. The more background children are exposed to a subjetc, the faster they will process new information. Prepare your child for topics he/she will encounter at school from young, in a fun and engaging way. Young children may not fully understand the concepts or terminology but these words will be "familiar" and they will feel more confident when they hear them at school later.

You could try this activity with your child. Through this activity, you are pre-exposing your child to concepts of weight, volume and density (ratio of mass over volume).

Collect a variety of objects around the house such as a leaf, a small rock, a toy car. Fill a large pail or the bath-tub with water. Ask your child to guess whether the item will sink or float before letting her place it into the water.

Explain to her that the items that float have lower density than water. Items that sink have higher density. Whether an item sinks or floats is not dependant on its weight only.You can try tricky ones like a sponge and an apple.A dry sponge will float. However, when air in the holes is replaced with water seeping into the sponge it will start to sink, as it becomes denser. An apple although as heavy as a small rock, will surprisingly float.

For older children you could pre-expose with these techniques:

Get the course description before term starts

Talk to past students

Reading other books on the subjects

Watching a video about the subjects or about the course itself

Get the text that is to be used

Bring your child for a family trip to relevant places such as the arts museum or the science centre

For maximum benefit of pre-exposure, keep things fun!

AcquisitionThis concerns your child's brain wires. For strong connections to form, the information given must be meaningful. That is why pre-exposure is important.

Acquisition can be direct or indirect. Direct acquisition is mainly from classroom teaching. At home, use indirect acquisition such as related visuals or models.

Things you can do to enhance indirect acquisition:

Teach your child concept of parts and names of different aspects of an aeroplane by constructing one rather than reading it from a book.

help your child design her own alphabet poster. This will provide indirect acquisition of what is taught at school.

ElaborationAt this stage, encourage your child to interconnect topics together and dig deeper. you can help strengthen elaboration by:

Role playing Allow your child to play the teacher, because one of the best ways to learn something is to teach it.

Provide hands-on experience and link it to life experience

Here are some simple activities you can do at home with your young child whereby you are interconnecting topics together, digging deeper, providing hands-on experience and linking it to your child's life.

My family treeYou could make history come alive and significant for your child by constructing a family tree with her. When constructing a family tree, your child will be able to grasp and interconnect concepts like past and present, family relationships and learn how all these are linked to him/her. For very young children, you may like to paste a photo of the person next to their names.

Colour my worldTry this painting activity with your child to help understand primary colours, secondary colours and tertiary colours. Your child will also be able to link this to her life through problem solving.Paint a picture with your child but have only three colours available-blue, red and yellow. Mention these as primary colours. Create a situation where your child will need green, a secondary colour. Guide her to solve the problem by mixing the two primary colours, blue and yellow together. Do not teach but let your child experiment. Tertiary colours are colours from mixing three primary colours together. Try it and let your child see what colours usually come up!

Memory formationMemory formation is the cement of learning. Memory is affected by:

Memory may also be enhanced by understanding how memory is formed and stored. Then by using brain-based learning techniques to process the information you may help strengthen the memory trace.

Functional integrationThis stage of learning is a reminder to use the new learning so that it is further reinforced. It is part of maintaining all the brain connections formed. When connections are not maintained by usage, it will slowly be pruned off.

Try this activity with your child at home.

Where's my breakfast?While doing this activity, your child will encounter chemistry and mathematics in the kitchen and concepts of food supply and economics in the supermarket, functionally integrating and reinforcing information together.

Bring your child to the supermarket to buy the ingredients needed for making pancakes. Ask your child where the flour, milk and egg originate from. Invite your child to work out how much to pay. Make the pancakes with your child and enjoy the pancakes together.What you'll need:a. 1/2 cup self raising flourb. 1/4 cup milkc. 1 large eggd. 2 drops vanilla essencee. 2 tsp margarine or butter

What you'll do:a. Mix first 4 ingredients into a bowlb. Put 1/2 tsp margerine into hot pan and spoon mixture in .c. Cook on medium heat till evenly brown on both sides.d. Repeat till all pancake mixture is finished.e. You should get about 4 little pancakes.

Chemistry1. Gluten (a mixture of proteins) in the flour gives pancakes a bread-like texture2. The pancakes brown because of a chemical reaction between sugar in the milk (lactose) and protein in the mixture known as the Maillard reaction

Mathematics1. Counting, measuring and learning parts of a whole when measuring ingredients.2. Adding and subtracting money

Food supplyLearn origins of flour from milled wheat, eggs from hens and milk from cows. You can further explore this subject with visits to the farm or reading books such as the charming children's book "pancake, pancake" by Eric Carle.

Friday, March 9, 2007

menses, am i bleeding?

bleeding,the cause of the irregular bleeding is not found. For these women the most likely reason is a change in hormonal activity. This is described as dysfunctional uterine bleeding.

This is the most common cause of abnormal vaginal bleeding during a woman's childbearing years. Up to 10% of women may experience excessive bleeding at one time or another. African American women tend to have more episodes.

When the complex hormonal process that creates your menstrual period loses coordination and the hormones oestrogen and progesterone are out of balance, your body overproduces uterine blood flow. Thus, you may experience excessive vaginal bleeding. This bleeding is related to irregularities of your menstrual cycle without any evidence of disease.

The diagnosis of dysfunctional uterine bleeding is a diagnosis of exclusion, which means that all other causes for the bleeding (including trauma, lesions, or diseases) have been looked for and determined not to be the cause of the bleeding.

Diagnosis methodsDiagnosing abnormal bleeding involves a number of tests. Your healthcare provider will take a careful medical history. You will be asked questions about the following issues and other general questions regarding your health:

* This episode of vaginal bleeding

* Your last known normal menstrual cycle

* Previous episodes of abnormal bleeding

* Currently pregnancy (if any)

* Previous pregnancies

* Outcomes of previous pregnancies

* Present sexual activity

* Use of any form of birth control

* Number of sexual partners

*Any medications, over-the-counter, or illicit drugs you are taking

The doctor will also perform a complete physical, including a thorough pelvic exam. The exam includes careful inspection of your external genitalia, urethra, and anal area.The vaginal walls and cervix or birth canal are inspected for the presence of any lesions or retained foreign objects.Sometimes a tampon or other object is left in the vagina and can cause bleeding.

While the doctor is examining your vagina and cervix, the doctor may take cultures (fluid samples) to test for sexually transmitted diseases such as gonorrhea and chlamydia.The doctor may also take cells from the cervix that wil be examined for cancer. This is a Pap smear.

It is also important for the doctor to place his or her hand ito your vagina and sometimes your rectum to detect the shape of your uterus and ovaries as well as to feel for any masses that may be present.Tests that may be performed with abnormal uterine bleeding include the following:

* A pregnancy test needs to be done to make sure that pregnancy is not the cause of your bleeding.

* Blood wil be taken to see if you are anaemic (have low red blood cell counts) or have a low platelet count.

* A clotting series that includes a prothrombin time (PT) and an activated partial thromboplastin time (PTT) gives information about your ability to form clots in your body to stop bleeding. Abnormal vaginal bleeding may be the first sign that you may have a bleeding disorder.

*Your doctor may also order thyroid tests, which are blood tests that examine the thyroid gland (a gland in the neck responsible for many complex functions of the body).

* Further tests, such as an ultrasound scan of the uterus, may be recommended. This is a simple test in which gel is placed on the lower abdomen and a special scanner is moved through the gel. If necessary, a vaginal ultrasound may occasionally be performed, in which the scanner is placed inside the vagina instead of on the abdomen. In this way, clearer and more accurate views of the uterus can be obtained.

* A vaginal ultrasound to look at the lining of the womb can also detect endometrial hyperplasia (thickening of the lining of the womb), uterine fibroids and routinely check for ovarian cysts and other pelvic abnormalities.

* An endometrial biopsy may be performed to take tissue form your uterus. This is performed in the doctor's office and is a little more invasive than a Pap smear.

* A hysteroscopy may be indicated. This involves a long fine telescope, used to look at the lining of the uterus(the endometrium) from the inside, usually under general anaesthetic. It may be performed as a day case or it may involve an overnight stay in hospital. At the start of the procedure, the doctor dilates the cervix slightly, so that the telescope can be inserted through the cervixtowards the inside of the uterus. With this technique, it is possible to take a biopsy (remove tissue for examination) from specific areas of the lining of the uterus.Treatment options Fortunately, most heavy bleeding can now be easily treated without major surgery.

*Medicines.Prostaglandin inhibitors and tranexamic acid are non-hormonal therapy that works on the clotting mechanisms in the lining of the uterus. Tablets are taken only on days when you have heavy bleeding. it may decrease heavy flow, but may lengthen the time of bleeding. Birth control pills may also decrease bleeding by almost a third. Most bleeding caused by hormone imbalance can be treated medically.

* Progesterone Intrauterine System(IUS)The Mirena progesterone IUS may decrease bleebing. It steadily releases a tiny amount of progestogen within the cavity of the uterus. This keeps the lining of the uterus(endometrium) thin and inactive rather than increasing in thickness as it normally would in the build-up to ovulation. Menstruation normally occurs when the lining of the uterus falls away, in this case, because the lining of the uterus has not increased in thickness the menstrual bleeding is reduced.Treating uterine problems

* Dilatation and curettage (D&C)The cervix is dilated and the endometrium gently scraped away. If abnormal bleeding is caused by polyps, often, removing them with the curette will solve the problem.

* Endometrial ablationSometimes an endometrial ablation is done at the same time to further reduce or eliminate bleeding. Endometrial ablation is a day surgery procedure that will usually eliminate or greatly decrease menstrual bleeding.Since an endometrial ablation destroys the lining of the uterus, endometrial ablation is not for anyone, especially those who desire to keep her fertility. Women who have a malignancy or pre-malignant condition of the uterus are not candidates for ablation. Women who have severe pelvic pain, unless the pain is coming from an intracavitary myoma, may be better served by alternative treatments. Although pregnancy is unlikely after ablation, serious complications could arise. It is essential for a woman to use reliable contraception after an endometrial ablation.HysterectomyOne of the reasons women get hysterectomies is to control heavy menstrual bleeding. This is the only procedure that guarantees permanent elimination of any bleeding.Hysterectomy is the removal of the uterus. The operation can be done in three ways:* Abdominal hysterectomy is when the uterus is removed through a cut in the abdomen

* Vaginal hysterectomy is when the uterus is removed through the opening of the vagina

* Laparoscopically assisted vaginal hysterectomy also involves removing the uterus through the vagina but there are small cuts made in the abdomen to allow the surgeon to do part of the operation. The aim of this operation is to reduce recovery time and discomfort after operation.The type of hysterectomy a woman has is dependent on a range of factors, including the nature of her problem and her medical history. Any decision to undergo hysterectomy, other than pre-cancer or cancer changes needs to be carefully discussed. Sometimes it is wise to seek a second opinion and to review options for other treatments.What should you do if you experience irregular vaginal bleeding?See your health care provider for any abnormal vaginal bleeding. It is not always necessary to go to a hospital emergency department for this problem. An office visit to a gynaecologist (a doctor who specialises in female reproductive organs) is usually sufficient if you are bleeding but do not have any other symptoms.Be certain to record when the bleeding occurs during the month. Also, try to determine if the bleeding is vaginal or anal. Don't be frightened-most irregular vaginal bleeding has a benign cause. If you're having heavy vaginal bleeding-saturating a pad an hour for more than a couple of hours-seek prompt medical attention.If you're taking birth control pills or are on hormone therapy, consult your doctor and follow the instructions he or she gives you. This may be as simple as taking more pills, but you may need to change medicines completely.If you are having abnormal vaginal bleeding with other symptoms, such as lightheadedness, severe abdominal pain, or fevers, or if you're pregnant and experience vaginal bleeding, you should be evaluated as soon as possible. This includes being seen in an emergency department.What is the outcome of having abnormal vaginal bleeding?The outcome depends on the cause of the problem, but abnormal vaginal bleeding rarely results from a serious condition and can usually be treated successfully.

Stopped having periods.

Whos's at risk?

What causes abnormal vaginal bleeding and who is at risk? Abnormal vaginal bleeding may occur between the normal menstrual bleeds (intermenstrual bleeding)or it may take the form of unusually heavy menstrual bleeding (menorrhagia). In postmenopausal women, it may develop after a number of years without any vaginal bleeding.

It's inportant to understand exactly what is causing the bleeding and where it's coming from (uterus, vagina, or some other organ or tissue) and to make decisions about how to control or stop the bleeding.

A wide range of "normal" menstrual periods Periods differ from woman to woman and from month to month. A period can last from three to 10 days, and occur every three to six weeks. This pattern can vary with age, stress, diet, exercise and inherited factors. The flow can also vary. Around 40ml (two tablespoons) of fluid is lost, which the body quickly replaces.It is common for women to suffer some cramping pain with their period. This is felt just below the navel and may spread ito the legs or lower back. It can be felt as a dull ache or sharp twinge. During a period, it is also common to feel bloated and heavy, get more pimples, feel tense and emotional, and have sore breasts and greasier hair.

What gynaecologic conditions are associated with irregular vaginal bleeding?Irregular vaginal bleeding is a possible sign or symptom of a range of causes. For others, the cause depends on their age and the site of bleeding. Once pregnancy has been ruled out, some of the known causes include:

Dysfunctional uterine bleeding

Contraception-such as the pill, injection or IUD (intrauterine device)

Vaginal infections

Tumours, polyps or fibroids of the vagina, cervix, uterus or fallopian tubes

Cervical disorders-such as cervical ectropion, a condition common among younger women, especially young women taking birth control pills-in which the cervical tissue becomes more susceptible to abrasion, often associated with bleeding after sexual intercourse

Cancer of the uterus, cervix, vagina or vulva

Some sexually transmitted diseases, such as chlamydia, gonorrhea or genital warts

Vaginal injury from trauma or sexual abuse

Some medications such as anticoagulants or anti-epilepsy drugs

Underlying health problems such as bleeding or thyroid disorders.Dysfunctional uterine bleedingIn more than half the women with